2011 Starts Off With More Stories On Top Prescribers

The investigation initially focused on a Miami Psychiatrist who wrote $43 Million worth of prescriptions from 2004-2009. It was calculated that psychiatrist Fernando Mendez-Villamil wrote an average of 153 prescriptions a day for 18 months ending in March 2009. On June 21, 2010 the Florida Agency for Health Care Administration terminated its Medicaid contract with Mendez-Villamil.

As a result, stories regarding top prescribers have now been published on 22 states and the District of Columbia: Alabama, Arizona, California, Connecticut, DC, Florida, Indiana, Iowa, Maryland, Minnesota, Mississippi, Montana, Nebraska, New Jersey, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Virginia, West Virginia, Wisconsin (see below)

Iowa Sen. Chuck Grassley is attracting widespread attention for his investigation into the nation's top Medicaid prescribers

Montgomery County police in 2000 found a woman fading in and out of consciousness in a house so squalid it would soon be condemned as unfit for human habitation. At the hospital, the patient, who had attempted suicide before, was found to be full of booze and the same type of medications that had been prescribed by Joel Cohen, who, as it turned out, was her fiance.

For more than a year, Cohen, then a psychiatrist in Bethesda, had been prescribing the woman medications such as hydrocodone and the anti-anxiety drug diazepam but failed to keep records, according to the Maryland Board of Physicians, which placed him on probation in 2001.

In February 2006, that probation was lifted. Five months later, Cohen was sanctioned again after what the board called a “dangerous failure to meet the standard of care” with a second patient, for whom he prescribed “large amounts of medications” despite her history of alcohol and prescription drug abuse. Cohen did this, according to the board, even while he “was aware that the patient was abusing prescription medications,” including the stimulant Ritalin.

In 2008, according to the D.C. Board of Medicine, Cohen was the District’s top prescriber under Medicaid of three antipsychotic medications: Seroquel, Abilify and Geodon.

In the 2006 sanction, the Maryland board said Cohen had committed “egregious boundary violations” with the patient, a victim of spousal abuse who had developed borderline personality disorder. He gave gifts to her children, allowed her to take his children on vacation and gave her real estate advice. He also let the patient, whom he had been treating for 21 years, shower at his office and prescribed Ritalin for her son without evaluating him.

Cohen admitted to the board that he had “mishandled the patient’s case in many ways and had underestimated his own difficulties,” according to the board’s final order in the case.

In that second sanction, the board said Cohen’s actions “were not a one-time, short-term lapse of judgment with one patient, but rather a longstanding, documented pattern of unethical behavior dating back to 1977.”

Cohen’s license in Maryland has expired, but he continues to practice at Community Connections, a clinic on Capitol Hill.

One patient’s fiancee asked the doctor to please stop prescribing so many medications. The patient was an alcoholic with a history of abusing narcotics and sedatives. Once, he overdosed, and now he was in a detox clinic. Still, the doctor did not stop prescribing, according to Maryland’s Board of Physicians.

Grassley requested data about the top 10 Medicaid prescribers of Abilify, Geodon, Seroquel, Zyprexa, Risperdal, OxyContin, Roxicodone and Xanax from each state. He wanted to know each prescribing physician’s identifier number, the number of prescriptions per drug each physician had written for 2008 and 2009, and the total amount billed to Medicaid per drug.

What Grassley would find from some of the states that complied with his request is that some physicians were writing thousands of prescriptions for these drugs. He also found that some of these same physicians were being investigated for fraud, or had been kicked out of their state Medicaid programs for fraud.

In Florida, for example, a physician was found to have written 96,685 prescriptions for mental health in 21 months. Grassley’s office calculated that this physician would have had to write more than 150 prescriptions a day, seven days a week and no vacations for almost two years.

Alabama’s top providers

Abilify, Risperdal and Zyprexa appear to be the prescription drugs that these top 10 physicians were paid the most for prescribing. Several physicians were paid between $400,000 and just more than $740,000 in some years for prescribing these drugs.

Ten doctors in Iowa wrote 23,220 prescriptions for eight painkillers, anti-anxiety and antipsychotic drugs in 2008, valued at nearly $4.7 million. Those numbers increased to 32,358 prescriptions and $6.1 million in 2009.

Waterloo psychiatrist Dr. Marvin Piburn Jr … who works at the Black Hawk-Grundy Mental Health Center in Waterloo, the Independence Mental Health Institute and several other northeast Iowa clinics, was the top prescriber of Xanax in 2008 and 2009.

The 915 Xanax prescriptions he wrote last year pales in comparison to a Texas doctor who wrote 14,170 prescriptions for the same anti-anxiety drug that year.

A Miami doctor who wrote nearly 97,000 Medicaid prescriptions in 18 months for mental health drugs and an Ohio physician who wrote about 102,000 prescriptions in two years were the types of cases that precipitated Grassley’s investigation.

Child psychiatrist Dr. Larry Richards … was the top Abilify prescriber in 2009, with 844 prescriptions.

With a paid amount of more than $1.9 million for the top 10 prescribers in 2009, the drug led Iowa’s list in cost.

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CCHR Florida

The Citizens Commission on Human Rights of Florida is a non-profit watchdog organization that investigates and exposes psychiatric abuse and educates the public about their rights in the field of mental health.

CCHR Florida provides only facts and does not provide medical or legal advice.

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